Healthcare Provider Details

I. General information

NPI: 1174588800
Provider Name (Legal Business Name): JENNIFER JILL FISCHER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JENNIFER GREEN

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 213
LEBANON NH
03766
US

IV. Provider business mailing address

20 W PARK ST STE 213
LEBANON NH
03766
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-5318
  • Fax:
Mailing address:
  • Phone: 603-448-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1118
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1118
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: